- Email: [email protected]
0155 Memory impairment and frequency of visual field deficits in standard temporal lobectomy and selective amygdalohippocampectomy
Poster Abstracts
Monday, November 7, 2005
decreased. The incidence of cognitive complaints between two drugs was also significantly different (i~ -- 0.03). In conclusion, TPM has negative effects on cognition such as attention, memory, and verbal fluency compared with OXC. 0152 Is color modulation an independent factor for
photosensitive epilepsy?
Parra, j 1 Lopes da Silva, F a:e, Dekker, E a, Wit, C a, Kalitzin, S a.
1Dutch Epilepsy Clinics Foundation, SEIN, Meer en Bosch, Heemstede, The Netherlands; 2Swarnmerdam Institute for Life Sciences, University of Amsterdam, The Netherlands Background: The role o f color in photosensitive epilepsy (PS E) remains controversial. We design a study to compare the potential of different colors, color combinations and white light to trigger photoparoxysmal responses (PPRs) under controlled conditions. Method: We studied 27 consecutive PSE patients (mean age 21 years, 20 women), using a specially designed stimulator. Stimuli included: pulse trains of white light, all primary colors and isoluminant alternating time-sequences of these, between 10 and 30 Hz. flhiminance was constant at 100 lm,~.A progressive stepwise increase of the modulationdepth (MD) of the stimuli was used to determine PPRs threshold. Re~ult~: Sixteen patients (59,2%) showed PPRs (Waltz's score > 2) at least in one session. Colored stimuli elicited PPR's in all these patients, whereas white light did so in 11 o f these. Red-blue was the most provocative stimulus, especially below 30 Hz (100% patients, mm,~. Z-score:l.51 at 15 Hz). Of the primary colors, red elicited more PPRs and at a lower M D (14/16 patients 0nax Z-score 0.82 at 30 Hz). Blue-green was the safest stimulus, eliciting PPRs in only 6/16 patients (max Z-score 0.48 at 10 Hz). Sensitivity to color combinations was not correlated to sensitivity to individual colors. Conclusion: Color sensitivity follows two different mechanisms: one, dependent on color modulations, plays a role at lower frequencies (< 30 Hz). Another dependent on monochromatic light modulation correlates to wlffte light sensitivity is activated at higher fiequencies. Our results suggest that colored lenses, tailored to the patient, can be effective preventative measures against visually induced seizures.
0153 Anti-Epileptic Drug Use is Associated with a Change in Body Fat Distribution with an Increased Proportion of Abdominal Fat: A Discordant Twin-Sister DEXA Study Petty, S, O'Brien, T, Paton, L, Kantor, S, Makovey, J, Berkovic, S, Sambrook, P, Wark, J. Department of Medicine, University Of
Melbourne, Melbourne, Australia; Institute of Bone and Joint Research, .Royal North Shore Ho@ital, Sydney, Australia; Epilepsy .Research Centre, The University of Melbourne, Austin Health, Melbourne, Australia Background: Anti-epileptic medication (AED) usage is associated with total body weight change. Body fat distribution changes have important health implications independent of total body weight. Dual energy x-ray absorptiometry (DEXA) is valuable for assessment of body fat distribution, and has not previously applied to study AED effects. Aim: Utilize AED usage-discordant twin and matched sister approach to examine effect o f A E D use on body fat distribution. Method: 37 female twin and 4 sister (matched witlffn 3 years of age) pairs studied. Pairs were discordant for AED use (users having > 12 months treatment). Body composition, including fat distribution, was measured using DEXA. Abdominal fat was expressed as a percentage of: abdominal region (Afat%); total trunk fat (AfatTT%), and total body fat (AfatTB%). Paired t-tests were utilized to test for within-pair differences between AED users and non-users. Re~ult~: Significant within pair difference user vs. non-user for Afat% (+6.0%, 35.8"/o vs. 29.8%, p -- 0.003) and AfatTB% (+1.0%, 7.61% vs. 6.61"/o, p - 0.015). N o SWPD in waist-hip ratio, height, weight,
S139
total body fat mass, lean mass, body mass index (BMI), systolic blood pressure (SBP) and diastolic (DBP). In current AED users the differences were seen only in valproate users (Afat% + 11.3%, p 0.033; AfatTB% + 1.23%, p - 0.015). Strong correlation between increase in Afat% and higher SBP (all participants r - 0.736, p < 0.001) and DBP (r -- 0.663, p < 0.001). Conclusion: A E D users have significant increase in Afat%, most marked in current valproate users. The strong correlation between increased Afat% (DEXA) and elevated SBP and DBP suggests these changes may have general health implications. 0154 Levetiracetam in intractable idiopathic generalized and localization related epilepsy: clinical experience in a tertiary care centre Pillay, N, Martini, J, Hanson, A, Murphy, W, Federico, P, Klassen, B.
University of Calgary, Calgary, Canada Background: To evaluate the safety and efficacy of Levefiracetam (LEV). We analyzed the majority of cases started on LEV from an adult epilepsy centre. Method: Epilepsy classification, concomitant AEDs, retention, duration of treatment, reasons for discontinuation, titration, maintenance doses, concurrent therapy, adverse effects and responses were analyzed. The primary end points were seizure freedom at 12 months (_>50% responder or < 50%), discontinuation of LEV, adverse effects, lack of efficacy or both. Results: Seventy males and 67 females, mean age 36.7 years, the majority (1119/137) with partial or generalized, ctyptogenic/symptomatic and 19 idiopathic generalized epilepsy, were treated. All patients were followed for a mean o f 12 months. Titration was slow (<500 mg/ day/week) in 76 and _>500 mg b.i.d, in 61. LEV was discontinued in 41 (130%) due to side effects. Fatigue (117/137), dizziness (9/137) and drowsiness (9/137) were the most common adverse effects. Behavioral adverse effects (BAE) occurred in 16"/o (122/137). Depression (13.6"/o), aggression (3.6%) and emotional lability (3.0%) were the commonest BALE. BAE was the most common reason for LEV discontinuation. At one year or later 56% (145/88) had _>50% seizure improvement. Withdrawal to monotherapy was successful in 5% (7/137). In the same cohort 19"/o (117/88) at 6 months and 24% (121/88) at one year or > were seizure free. Conclusion: LEV is effective not only as adjunctive therapy in intractable localization related but also idiopatlffc generalized epilepsies. About 1/3 discontinued treatment with LEV because of adverse effects. Although sedation was the commonest adverse effect, BAE was more likely reason for discontinuation. A significant number of patients in the cohort were seizure free at six and > 12 months respectively
0155 Memory hnpairment and frequency of visual field deficits in gtandard temporal lobectomy and selective amygdalolfippocampectomy Pillay, N 1, Hader, W 1, Partlo, L2, Myles, T 1, Weibe, S 1. 1University Of
Calgary, Department of Clinical Neurosciences, Canada; 2 University of Calgary, Department of Psychology, Canada Rationale of sludy: Surgical treatment for temporal lobe epilepsy refractory to medical therapy is a proven therapeutic option. Memory impairment and visual field deficits (VFDs) are relatively common complications of temporal lobe surgery. Tiffs study was done to determine whether there was a difference in memory impairment and frequency of VFDs in standard anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy (SAH). Methods: All patients with refractory temporal lobe epilepsy had either transcortical SAH or ATL extending to 4.5 cm on the dominant middle temporal gyms and 6 cm on the non-dominant temporal lobe. Patients had pre and post surgery neuropsychological assessments but Goldinann visual field perimetry (GVP) was done only after surgery.
Monday, November 7, 2005
decreased. The incidence of cognitive complaints between two drugs was also significantly different (i~ -- 0.03). In conclusion, TPM has negative effects on cognition such as attention, memory, and verbal fluency compared with OXC. 0152 Is color modulation an independent factor for
photosensitive epilepsy?
Parra, j 1 Lopes da Silva, F a:e, Dekker, E a, Wit, C a, Kalitzin, S a.
1Dutch Epilepsy Clinics Foundation, SEIN, Meer en Bosch, Heemstede, The Netherlands; 2Swarnmerdam Institute for Life Sciences, University of Amsterdam, The Netherlands Background: The role o f color in photosensitive epilepsy (PS E) remains controversial. We design a study to compare the potential of different colors, color combinations and white light to trigger photoparoxysmal responses (PPRs) under controlled conditions. Method: We studied 27 consecutive PSE patients (mean age 21 years, 20 women), using a specially designed stimulator. Stimuli included: pulse trains of white light, all primary colors and isoluminant alternating time-sequences of these, between 10 and 30 Hz. flhiminance was constant at 100 lm,~.A progressive stepwise increase of the modulationdepth (MD) of the stimuli was used to determine PPRs threshold. Re~ult~: Sixteen patients (59,2%) showed PPRs (Waltz's score > 2) at least in one session. Colored stimuli elicited PPR's in all these patients, whereas white light did so in 11 o f these. Red-blue was the most provocative stimulus, especially below 30 Hz (100% patients, mm,~. Z-score:l.51 at 15 Hz). Of the primary colors, red elicited more PPRs and at a lower M D (14/16 patients 0nax Z-score 0.82 at 30 Hz). Blue-green was the safest stimulus, eliciting PPRs in only 6/16 patients (max Z-score 0.48 at 10 Hz). Sensitivity to color combinations was not correlated to sensitivity to individual colors. Conclusion: Color sensitivity follows two different mechanisms: one, dependent on color modulations, plays a role at lower frequencies (< 30 Hz). Another dependent on monochromatic light modulation correlates to wlffte light sensitivity is activated at higher fiequencies. Our results suggest that colored lenses, tailored to the patient, can be effective preventative measures against visually induced seizures.
0153 Anti-Epileptic Drug Use is Associated with a Change in Body Fat Distribution with an Increased Proportion of Abdominal Fat: A Discordant Twin-Sister DEXA Study Petty, S, O'Brien, T, Paton, L, Kantor, S, Makovey, J, Berkovic, S, Sambrook, P, Wark, J. Department of Medicine, University Of
Melbourne, Melbourne, Australia; Institute of Bone and Joint Research, .Royal North Shore Ho@ital, Sydney, Australia; Epilepsy .Research Centre, The University of Melbourne, Austin Health, Melbourne, Australia Background: Anti-epileptic medication (AED) usage is associated with total body weight change. Body fat distribution changes have important health implications independent of total body weight. Dual energy x-ray absorptiometry (DEXA) is valuable for assessment of body fat distribution, and has not previously applied to study AED effects. Aim: Utilize AED usage-discordant twin and matched sister approach to examine effect o f A E D use on body fat distribution. Method: 37 female twin and 4 sister (matched witlffn 3 years of age) pairs studied. Pairs were discordant for AED use (users having > 12 months treatment). Body composition, including fat distribution, was measured using DEXA. Abdominal fat was expressed as a percentage of: abdominal region (Afat%); total trunk fat (AfatTT%), and total body fat (AfatTB%). Paired t-tests were utilized to test for within-pair differences between AED users and non-users. Re~ult~: Significant within pair difference user vs. non-user for Afat% (+6.0%, 35.8"/o vs. 29.8%, p -- 0.003) and AfatTB% (+1.0%, 7.61% vs. 6.61"/o, p - 0.015). N o SWPD in waist-hip ratio, height, weight,
S139
total body fat mass, lean mass, body mass index (BMI), systolic blood pressure (SBP) and diastolic (DBP). In current AED users the differences were seen only in valproate users (Afat% + 11.3%, p 0.033; AfatTB% + 1.23%, p - 0.015). Strong correlation between increase in Afat% and higher SBP (all participants r - 0.736, p < 0.001) and DBP (r -- 0.663, p < 0.001). Conclusion: A E D users have significant increase in Afat%, most marked in current valproate users. The strong correlation between increased Afat% (DEXA) and elevated SBP and DBP suggests these changes may have general health implications. 0154 Levetiracetam in intractable idiopathic generalized and localization related epilepsy: clinical experience in a tertiary care centre Pillay, N, Martini, J, Hanson, A, Murphy, W, Federico, P, Klassen, B.
University of Calgary, Calgary, Canada Background: To evaluate the safety and efficacy of Levefiracetam (LEV). We analyzed the majority of cases started on LEV from an adult epilepsy centre. Method: Epilepsy classification, concomitant AEDs, retention, duration of treatment, reasons for discontinuation, titration, maintenance doses, concurrent therapy, adverse effects and responses were analyzed. The primary end points were seizure freedom at 12 months (_>50% responder or < 50%), discontinuation of LEV, adverse effects, lack of efficacy or both. Results: Seventy males and 67 females, mean age 36.7 years, the majority (1119/137) with partial or generalized, ctyptogenic/symptomatic and 19 idiopathic generalized epilepsy, were treated. All patients were followed for a mean o f 12 months. Titration was slow (<500 mg/ day/week) in 76 and _>500 mg b.i.d, in 61. LEV was discontinued in 41 (130%) due to side effects. Fatigue (117/137), dizziness (9/137) and drowsiness (9/137) were the most common adverse effects. Behavioral adverse effects (BAE) occurred in 16"/o (122/137). Depression (13.6"/o), aggression (3.6%) and emotional lability (3.0%) were the commonest BALE. BAE was the most common reason for LEV discontinuation. At one year or later 56% (145/88) had _>50% seizure improvement. Withdrawal to monotherapy was successful in 5% (7/137). In the same cohort 19"/o (117/88) at 6 months and 24% (121/88) at one year or > were seizure free. Conclusion: LEV is effective not only as adjunctive therapy in intractable localization related but also idiopatlffc generalized epilepsies. About 1/3 discontinued treatment with LEV because of adverse effects. Although sedation was the commonest adverse effect, BAE was more likely reason for discontinuation. A significant number of patients in the cohort were seizure free at six and > 12 months respectively
0155 Memory hnpairment and frequency of visual field deficits in gtandard temporal lobectomy and selective amygdalolfippocampectomy Pillay, N 1, Hader, W 1, Partlo, L2, Myles, T 1, Weibe, S 1. 1University Of
Calgary, Department of Clinical Neurosciences, Canada; 2 University of Calgary, Department of Psychology, Canada Rationale of sludy: Surgical treatment for temporal lobe epilepsy refractory to medical therapy is a proven therapeutic option. Memory impairment and visual field deficits (VFDs) are relatively common complications of temporal lobe surgery. Tiffs study was done to determine whether there was a difference in memory impairment and frequency of VFDs in standard anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy (SAH). Methods: All patients with refractory temporal lobe epilepsy had either transcortical SAH or ATL extending to 4.5 cm on the dominant middle temporal gyms and 6 cm on the non-dominant temporal lobe. Patients had pre and post surgery neuropsychological assessments but Goldinann visual field perimetry (GVP) was done only after surgery.